There is an increasing recognition that psychological issues are a primary concern for cancer patients, both during and after treatment. Anxiety, depression, fear of recurrence and other psychological concerns need to be addressed to maintain quality of life.
Did you know?
Approximately half of all patients with cancer experience emotional difficulties.1
Adjustment disorder is a common psychological complication, with individuals suffering from depressed mood, anxiety, lack of life satisfaction, hopelessness and/or loss of self-esteem.2
Non-specific distress and anxiety are also very common in cancer patients. Distress is the sum of multiple psychological, social, and spiritual factors. If severe enough, it can interfere with the patient's ability to deal effectively with the illness, its symptoms and the complications of treatment.
Psychological issues may impact behaviors that are critical for cancer survivors.3,4 In addition, survivors who have clinical depression have a two times greater risk of death from any cause, when compared to survivors who don’t have clinical depression.5
Unfortunately, research suggests that emotional needs of cancer patients are not met as they should be. For example, a survey of bone marrow transplant survivors found that half of those who reported feeling distressed said they had not received any treatment for their emotional needs.6
The Facts:
Adjustment disorder
- Adjustment disorder can occur when someone goes through a stressful life event, including the diagnosis of cancer.
- It can be addressed through individual psychotherapy by teaching coping skills that focus on stressors caused by the disease. Cognitive therapy was found to be useful in reducing distress and increasing quality of life in a group of patients with melanoma.7
- Patient support groups play an important role in coping with a cancer diagnosis and the resultant distress that many survivors experience. Support groups include tumour‐specific or mixed groups, and may be either informally structured, meet at regular face‐to‐face meetings or be run by professionals who provide expert education and training.8
- One study of 748 participants in cancer support groups in the UK showed that the most frequent reasons for joining a support group were meeting others like themselves (63.5%), finding emotional support (13%) and gaining practical advice (8%).9
Anxiety
- Approximately 18 to 25 percent of long-term cancer survivors report anxiety.10–14 Patients may present with a complex mixture of physical and psychological symptoms, which may be expressed as:
- Tension
- Restlessness
- Jitteriness
- Hypervigilance to symptoms and events
- Insomnia
- Distractibility
- Shortness of breath
- Emotional numbness
- Apprehension
- Worry
- Management of Anxiety
- Treatment of anxiety in patients with cancer involves a combination of psychotherapy, drug-free approaches and, in some cases, medications.
- Although many symptoms might be viewed as normal reactions to a cancer diagnosis and treatment, symptoms that are severe enough to interfere with quality of life or the ability to perform routine activities of daily living need further evaluation and treatment.
- Non-pharmacological therapy
- Non-pharmacological treatments for anxiety and distress include psychotherapy and behavioral interventions used alone or in combination.15
- Supportive psychotherapy
- This is a short-term, solution-oriented psychotherapy that focuses on a specific problem. It deals with both crisis-related issues as well as existential issues15 and can include both the patient and family.
- Behavioural intervention
- A typical behavioural intervention for anxiety includes a relaxation exercise, combining deep breathing and either passive or active muscle relaxation.
- There is evidence that progressive muscle relaxation might have benefits for patients undergoing chemotherapy.16
- A study comparing progressive muscle relaxation and alprazolam, a drug commonly used to treat anxiety, found that both were effective in relieving mild to moderate anxiety or distress in cancer patients.17 Relaxation techniques can be used in combination with medications for highly anxious patients.
- Exercise
- A program incorporating strength and aerobic exercise can help reduce anxiety, with greatest improvements seen in supervised training programs. Moderate-intensity aerobic training performed three times per week over at least a 12- week period, or a combination of aerobic plus resistance training twice weekly over a 6- to 12-week period, can significantly reduce anxiety in cancer survivors during and after treatment.18
- Stress management training
- Even watching a video or reading material that provides instructions on stress management techniques can be beneficial and has been recommended to relieve psychological distress during treatment.19
- Creative Arts therapies
- For cancer patients, creative therapies like art, dance, music, and writing, appear to offer some relief for both anxiety and depressive symptoms during treatment.20
- Management of Insomnia
- Insomnia can be a manifestation of anxiety in cancer patients. For this condition, cognitive-behavioral therapy (CBT) has been shown to help. CBT focuses on challenging negative or faulty thoughts and behaviours and developing healthier problem-solving skills to target difficult situations.
- A meta-analysis of CBT that included 752 cancer survivors with insomnia21 found that CBT improved sleep efficiency and reduced the severity of insomnia.
- Insomnia can be a manifestation of anxiety in cancer patients. For this condition, cognitive-behavioral therapy (CBT) has been shown to help. CBT focuses on challenging negative or faulty thoughts and behaviours and developing healthier problem-solving skills to target difficult situations.
Depression
- Depression in cancer patients can interfere with treatment and recovery and may subsequently affect their health, wellbeing and risk of death.22 Recognition of depression and choice of the appropriate level of intervention, ranging from brief counseling and support groups to medication and psychotherapy, is an important aspect of cancer care.23
- Medications
- These are usually prescribed for moderate to severe levels of depression. However, when compared to placebos, antidepressants for clinical depression in cancer patients do not appear to offer significant benefit. 24
- Psychotherapy
- Psychotherapy interventions are used to help individuals, families and groups to improve their coping skills.
- Both group and individual treatments are effective for reducing depressive symptoms and distress and improving quality of life.23 The benefits of psychotherapy are extensive for patients with advanced incurable cancer.25,26
- Cognitive Behavioural Therapy (CBT)
- CBT-based interventions help patients calm exaggerated fears by encouraging them to consider different possible outcomes for their situation. Helping the patient to focus on aspects of the disease and its treatment that they have control over and encouraging behaviour change that will keep them involved and positive could provide a better quality of life. These benefits also appear to have long-term effects, with patients reporting fewer depressive symptoms several years later.27
- Support groups
- Support groups are important for cancer patients and family members who are distressed.28 Hospitals and community organisations will often sponsor groups that are professionally run and/or offer self-help.
- Exercise
- Moderate-intensity aerobic training performed three times per week over at least a 12-week period, or a combination of aerobic plus resistance training twice weekly over a 6- to 12-week period, can significantly reduce depressive symptoms in cancer survivors during and after treatment.18 Improvements in depressive symptoms appear to be greater in supervised training programs that include aerobic exercise.
- Spiritual Interventions
- Patients with cancer may experience reduced depression and anxiety and greater spiritual wellbeing and quality of life from interventions focused on prayer, meditation and finding meaning and purpose.29
- Medications
What can we do about it?
If you are currently experiencing anxiety or depression after a cancer diagnosis, don't put on a "happy face" if you don't really feel this way. Share your concerns with your cancer care team.
Connect with others who listen and can help with the practical aspects of dealing with cancer. Asking family members and loved ones for this kind of support may help reduce your distress and the distress of those who care about you.
Consult with your doctor before commencing an exercise program. As much as possible, exercise regularly for at least 150 minutes per week at moderate intensity.
Try different behavioural techniques to relieve anxiety and depression, such as deep breathing and progressive muscle relaxation.
Engage in activities you really enjoy. Creative arts and music are good examples.
Go see a clinical psychologist or counselor.
Take time for spiritual reflection and prayer.
Summary:
As more research is completed, there is an increasing recognition that psychological issues are primary concerns for cancer patients during and post-treatment. Several interventions have been shown to alleviate psychological distress, anxiety and depression.
References
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